Evidence-Based Chiropractors: The Good, Bad, and Ugly
One of our greatest professional assets is the opportunity to spend quality time with our patients. Our ability to actively listen to a patient’s problem and accurately diagnose their condition is also our primary new patient generator. Yes, long-term practice success is a side effect of clinical excellence.
A basic history and exam allow us to determine WHAT tissue was injured, and possibly WHY that tissue was predisposed to injury. But we will be only able to determine HOW an injury occurred by carefully listening to our patients. Complete resolution of symptoms requires an understanding of the HOW, WHAT, and WHY.
Peer-reviewed research is necessary for evidence-based practice. This Foroughi paper is well-written and provides valuable insight into rehab for anterior knee pain. The author defines PFPS by what sometimes is referred to as the “WHAT”- or ICD-10 code. To be reimbursed by insurers, we need to know how to recognize the involved anatomical tissue.
The authors also go one step further to understand the “WHY” by suggesting that the “lumbopelvic-hip complex” may play a role in PFPS. We know that hip abductor weakness is common in patients with PFPS. Accordingly, the authors expand on traditional rehab with the inclusion of appropriate postural training.
Training on an unstable seat apparatus, which eliminates the influence of lower body movements on balance control, may have potential benefits for enhancing core muscle neuromotor control. The dynamic challenges of unstable sitting balance require a combined feedforward-feedback strategy in the trunk musculature to maintain spinal stability and postural equilibrium. Under such conditions, a strategy of spine stiffening through pre-activated, low-level muscle coactivation along with continuous trunk muscle adjustments in response to unstable sitting perturbations are needed to maintain trunk postural control.
Defining “WHY” means determining the causative factors behind a specific diagnosis—core instability, hip abductor weakness, scapular dyskinesis, etc. The ability to recognize the “WHY” is a skill that separates great clinicians from their mediocre peers.
First, the bad ones (I know, it’s not the order in the title, but this is the best way to present it). These are the ones you hear about mostly, the ones who claim that correcting vertebral subluxations (misalignments of vertebrae) can cure literally any disease in the body. At that point, you should be immediately suspicious. One of the first rules I use when dealing with medical woo claims is “There is no Panacea.” A single pill or procedure that claims to cure everything is almost always bogus; the body just doesn’t work like that. Aside from that, how about the fact that there is no evidence to support their claims. As one Chiropractor famously said, “That’s why we never use double-blind tests. They never work.”
Many of these Chiropractors belong to the International Chiropractors Association (ICA), the American Chiropractors Association (ACA), the National Association for Chiropractic Medicine, or the European Chiropractors Union. They have their own distinctions within themselves, but I’m not going to bother with it. It’s just a minor difference in what brands of woo they subcribe to.
It is a fact that there are several misconceptions about the capabilities and strengths of a chiropractor. Several people have unreasonable expectations from them. Chiropractors are trained for relieving the pain and suffering, but they aren’t the ‘one-point solution’ for all your problems. When they diagnose the problem correctly, they deliver much higher value than expected. For that, it is also vital that the chiropractors understand the ‘what,’ ‘how’ and ‘why’ part before performing the treatment.
Once the three questions are answered, the chance of exceeding patient expectation is high. Another ugly part with chiropractors is sometimes; they do not stop the treatment and suggest the patients to meet some expert. Even if there is no significant improvement happens after a few sittings, they prolong it as much as they can. It is not that there are always commercial interests, they just don’t want to give up.
In such condition, the patient gets the proper treatment delayed, and the case becomes complex. o Stapleton Chiropractic is the experienced chiropractor in Adelaide has Over 40 year’s professional experience in neck pain, lower back pain, shoulder pain and sciatica pain with aim to provide patients with quality chiropractic care at the most cost- effective price servicing in western and southern suburbs of Adelaide.
what is Posture, Ideal Posture or an Ideal Spine?
Posture is the way your body is held in space – standing and sitting under gravity (gravitational load). If your body has proper posture, there is balance to your physical structures and your spine requires minimal effort to maintain your body in a neutral position. Certain physical structures in your body line up correctly with your center of gravity.
At Integrity Chiropractic, our doctors evaluate your posture visually from the front and the side as well as measure it on x-rays for a complete analysis. This has been extensively studied and normative values have been published.
There are over 220 published papers on CBP technique of correcting abnormal postures towards normal. Ask your CBP chiropractor to evaluate your posture according to the literature.
Body Stressors of Bad Posture
Medical doctors have reported, and chiropractors agree that for every inch that your head is held forward, an additional 10 pounds of pressure is placed on the supporting tissues of your neck and shoulders. Muscles along the rear of your neck and the upper back are required to accommodate for this extra load. As a result, they’ll experience greater stress and strain.
Whenever the position of your body moves away from its center of gravity, your joints are taken out of their normal, stress-free positions and initiates abnormal wear and tear. Over time, joint cartilage erosion, bone spurs and pinched nerves are evidence of this phenomenon.
Are all chiropractors this crazy?!
Chiropractors fall into three main groups, often referred to as “straights”, “mixers” and “reformers”.
These guys are the 100% pure crackpots of the group. They really believe that all human illnesses result from subluxations. Evidence is not their strong suit. They have a philosophical outlook on medicine, not a science-based approach. About 15% of chiropractors are straights. That’s more than I’d like, but I’m thankful the number isn’t larger because these people are truly crazy.
This is by far the smallest group. They make up about 2% of chiropractors. They believe in eschewing the subluxation theory in favour of an evidence-based approach to chiropractic. In their view, chiropractic treatment should be restricted to muscular-skeletal ailments, the only area in which it has been conclusively shown to have any net positive effect.
This group is complicated. They make up the ~83% of remaining chiropractors. On the face of it it seems these guys should be more rational than the straights because they accept that not all disease is cured by spinal manipulation. In general they believe in the germ theory of disease and their practice is not limited to fixing subluxations. The problem is, although they promote other forms of treatment, in a very large number of cases (probably a majority, although I’m having trouble finding the numbers) they promote other alternative modalities in lieu of evidence-based medicine.
Many mixers supplement their subluxation therapies with homeopathy, acupuncture and other well known fraud-based medicine modalities. This isn’t surprising considering the anti-scientific approach to medicine that is positively rife within chiropractic circles.
Chiropractic schism cliffs
— Chiropractors range from the positively insane to the rational, but are heavily weighted towards the insane
— Straights reject the germ theory of disease and practice only subluxation therapy
— Reformers may as well by physical therapists, because that’s what they do
— Mixers are complicated but in general still believe in subluxation therapy and often compliment it with other unscientific modalities